Children develop strong attitudes toward smoking as early as 5 and 6 years of age, and those attitudes are key predictors of their smoking intentions, according to a study led by Dr. Dina Borzekowski, research professor in the Department of Behavioral and Community Health.

In the study, “Attitudes and intentions to smoke: A study of young Brazilian children,” published in the journal Child: Care, Health & Development, Dr. Borzekowski and her team found that 5- and 6-year-old children could assign positive and negative characteristics to photos of smokers and non-smokers.

Overall, children had a negative impression of smokers, and 8 percent of those studied expressed an intention to smoke. Parental smoking had a significant influence on children’s attitudes towards tobacco, according to the study, and anti-tobacco messages in cartoons are effectively contributing to negative impressions of smoking within this age group. In addition, researchers also found that children from rural areas were less vulnerable to tobacco messages than children from urban areas, and 5-year-olds were more vulnerable than 6-year-olds.

Two videos related to Dr. Borzekowski’s previous work on children’s perceptions of tobacco use and messaging won the Consortium of Universities for Global Health (CUGH) Global Health Video Competition in the Global Health Advocacy category. The videos were shown at the Global Health Film Festival at CUGH's Annual Conference on March 27 in Boston, MA, where Borzekowski was presented with the award.

Her research team’s films, “Scary Packages--Brazilian Children Speak” and “They’re Very Pretty--Russian Children Speak" highlight young children’s awareness of messages featured on cigarette packages. The children were asked to look at and react to the packages' logos and health warning labels. The study revealed that 5- and 6-year-olds have low levels of awareness of the harmful effects of tobacco, but can easily recognize the brands. Of the six countries studied (China, Russia, Pakistan, India, Nigeria, and Brazil), Brazilian children had the highest level of awareness.

In Brazil, graphic health warning labels are extremely provocative; some of the more striking images include deathly ill patients, gangrenous feet, and stillborn babies. Such warning labels have been featured since 2002 and cover 100 percent of the back of each cigarette package sold in Brazil. In countries where the warning label was text-based (Russia) or abstract (scorpion in India), children did not know about nor could they explain what was meant by the message.

The produced videos are meant to stimulate conversations and promote more widespread use of graphic health warning labels on cigarette packages. When disseminated to policy advocates, this work can dispel the erroneous belief that children just ignore warning labels. Greater promotion and distribution of these videos will offer visual evidence that anti-smoking messages can be effective.